ANOM Lapsus Presentation

7/25/2019 ANOM Lapsus Presentation

http://slidepdf.com/reader/full/anom-lapsus-presentation 1/36

ST Elevation MyocardialInfarction (STEMI)

Inferior

Cardiology DepartmentMedical Faculty of Hasanuddin

University

By :Anom Partha Jaya (C11112131)

Supervisor :dr. Pendrik Tandean Sp.P!"##$ %&'AS



$%TIE&T'S IDE&TIT

&ame Mr* S

+ender Male

%ge ,- years old

.egistration no* *+,,-

Date of %dmission 11+*2+1*



History Ta/ingChief Complaint:

Chest pain

Guided Anamnesis:

Occured about 6 hours before admitted to the hospital. The chest pai

was felt suddenly during rest. The pain was felt at the left side of th

chest and it feels like compressed pain, radiated to the left arm and als

radiated to the back associated with cold sweat. The duration of the che

pain occurs about 30 minutes and relieved by the time past. The historof chest pain before is denied. hort of breathness during laying down

denied, no history of coughing, fever, nausea and vomiting or epigastr

pain. !efecation and urination are normal.



$ast Illness History

• "istory of smoking since #0 years old, $%# packs of cigarettes in a day

• "istory of "ypertension, !iabetes &ellitus, "ypercholesterolemia denied



.is/ Factors

Non-Modified Risk Factor :'ender

(ge

Modified Risk Factor :

moking



Clinical E0amination

GENERAL STATE

&oderate illness) non obese) compos mentis *'C +&6-/

!TAL S!GN

lood pressure 1 $00)20 mm"g

ulse 1 40 bpm

reathing 1 ## times)min

Temperature 1 36,25C *(illa/



"ead E#amination• +yes 1 anemic %)%, icterus %)%, cyanosis %)%

• 7eck 1 tumor mass *%/, tenderness *%/,

8- 9:3 cm"#O, trachea deviation *%/

Chest E#amination

• ;nspection 1 symmetrical 9<=

• alpation 1 mass *%/, tenderness *%/

• ercussion 1 sonor 9<=

•lung%hepar border < right ;C ;-

•9ight back lung border < right C- th -;;;

•=eft back lung border < left C- th ;>

• (uscultation 1 breath sound 1 bronchovesicular

additional sound 1 ronchi %)% whee?ing %)%



Cardiac E#amination

• ;nspection 1 heart ape was not visible

• alpation 1 heart ape was not palpable

• ercussion 1 normal heart si?e

• (uscultation 1 9egular of ;);; heart sound,

murmur *%/



A$dominal E#amination ;nspection 1 flat and following breath movement (uscultation 1 peristaltic sound *:/, normal alpation 1 liver and spleen unpalpable ercussion 1 tympani *:/, ascites *%/

E#tremities% Oedema 1 pretibial %)%, dorsum pedis %)%



/0/CTCA!&A

.1yt1m sinus r1tymH. -2 3pm.egularity regular$ 4ave !*!- sec$. interval !*"# sec%0is &ormal a0is

Duration of 5.S !*!- ST segment

• ST elevation in lead 7.87,.

• ST depretion in lead I7" 7 72



/0/CTCA!&A



&'T/P/TAT&'

Conclusion

Sinus rhtym 4 53 6minute 'orma7 a6is in8erior 9a77myoardia7 in8artion and i;ht $entri7e &n8ark

.1yt1m sinus r1tymH. -2 3pm.egularity regular$ 4ave !*!- sec$. interval !*"# sec%0is &ormal a0is

Duration of 5.S !*!ST segment

• ST elevation in lead %7F6 7.87,.

• ST depression in lead%796 7"676 72

• T inverted in I6 %796 7

0ABAT< %&'!&'S



0ABAT< %&'!&'S

T/ST /S=0T 'A0

$A0=/

>BC 5* 6 1+3u0 ?.+ @ 1+.+ 6

1+3

BC -.*+ 6 1+*u0 ?.+ @ *.+ 6 1+*

4B 1*.2 12 @ 15

4CT ?* 3 @ ?5

P0T 1,5 6 1+3u0 1-+ @ ?++ 6

1+3

PT 1+? 1+ " 1?

APTT 231 22+ " 3++

&' 1++

lood

'lucose

12 m;d7

1+*

@ #00

$0ST ?+ u0 35

SPT 1 u0 ?1

TEST .ESU9T &:.

7%9

Tot.Cho7es 1,* m;d7 2+

4!0 3* m;d7 -

0!0 1-* m;d7 1

Tri;7yerides 11, m;d7 2+

=reum $ 1+"

Creatinin $,#6 1

Troponin & 1?5 +C# 3A# 1

C#B 0, 2

odium 1?1 13* "

potassium ,$ 3- "

h7oride 113 , "

Bric acid 2,0 3?"



C4/ST D"A<

Cardiome;a7y 9ith 7un; dam and di7atation o8 aortae

e7evation o8 diaphra;m de6tra



>#&' !&A'S&S

ST /7evation yoardia7 &n8artion (ST/&) &n8erior E i;ht$entri7e in8ark onset * 4ours



T4/AP<1. 2 2 0P via nasa7 anu7e

2. &$%! 'aC7 +,F -++ 2? hr&$

3. 0ovevo6 (/no6aprin 'a) +*12 hrSC

?. iniaspi 5+m;2? hrora7

-. C7opido;re7 - m;2? hrora7

*. Atrovastatin ?+ m;2? hrora7

. A7praGo7am +-m;2? hrora7

5. 0a6ative (0a6adine) syr 1-m72? hrora7

,. !oHutamin m;k;BBminuteSP (do9n titrasi)

1+. PP& (0ansopraGo7e) 3+m;2? hr ora7



esume

Sinus 4 53 6mnt 'orma7 a6is in8erior 9a77 myoardia7in8artion and i;ht $entri7e &n8ark

0aHoratory resu7t ST ?+ Trop 1?5 4!0 3* m;d7 0!0 1-*m;d7 C#B -+? C# 3,2

Cardiome;a7y 9ith 7un; dam and di7atation o8 aortae e7evation odiaphra;m de6tra



Di i



Diagnosis



$%T:$HSI:9:+



Atherosk7erosis tromHosis at oronaryarteries

!erease the H7ood o9 into the heart

!erease the supp7y o8 o6y;en andnutrition

&shemia myoard

'erosis

&mHa7ane supp7y and onsumption o8 theo6y;en into the heart

yoardia7 in8artion

$%T:$HSI:9:+



• Pro7on;ed hest pain

• =sua77y retrosterna7 7oation• !yspnea• !iaphoresis

&shemisymptoms

• Chan;es in seria7 /C train;s!ia;nosti

/C han;es

• Troponin"T• C#"B• C# • yo;7oHin

Serum ardiamarker

e7evations

>4 !&A'ST&C C&T/&A



Treatment

ST/&

Primary PC&

%iHrino7iti Theraphy

/mer;ent PC&avai7aH7e 9ithin

,+ min O

<es

'o



orphine 2"-m; iv (an He administered a;ain in -"3+

minutes 7ater)

%iHrino7yti therapy:Streptokinase 1.-mi77ion units iv

Tenetep7ase +.-m;k; Hody 9ei;ht iv

Antioa;u7ation therapy:

0o9 o7eu7ar >ei;ht 4eparins (%ondaparinu6)2.-m;2?hrss 8or up to 5 days post"&.

=n8rationated heparin

Anti 4ypertension !ru;s

0ipid 0o9erin; A;ents

&'&T&A0 T/AT/'T



Comp7iation

1. i;ht $entri7e &n8ark

in 3+"-+F ases in8erior in8ark is 8o77o9in; Hy ri;ht ventri7ein8ark

&n e6amination an %ind trias: hypotension , clear lung-no ronkhiand elevation of JVP

Has a dierent treatment than another ACS, e should avoid touse drugs such us !itrates, "eta "locker



2. 4eart %ai7ure 3. 4ipotension (4emodynami disturHanes)

?. Cardio;enik Syok

-. Arrhythmia

*. A$ H7ok ondution disturHanes

. Periarditis



C7ass !esription orta7ity a(F)

& no 7inia7 si;ns o8 heart8ai7ure

*

&& ra7es or rak7es in the 7un;san S3 and e7evated Ru;u7ar

venous pressure

1

&&& aute pu7monary edema 3+ " ?+

&$ ardio;eni shok orhypotension (systo7i BP ,+mm4;) and evidene o8periphera7 vasoonstrition

*+ @ 5+

$rognosis=I99I$ C9%SSIFIC%TI:&

http:en.9ikipedia.or;9iki#i77ip7ass



TH%&= :U

ANOM Lapsus Presentation

Documents

Transcript of ANOM Lapsus Presentation